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Khan S, Solano-Paez P, Suwal T, Al-Karmi S, Lu M, Ho B, Fouladi M, Leary S, Levy JMM, Lassaletta A, Rivas E, Reddy A, Gillespie GY, Gupta N, Yalon-Oren M, Amariglio L, Nakamura H, Wu KS, Wong TT, Ra YS, Spina ML, Emanuele PV, Massimi L, Buccoliero AM, Hansford JR, Grundy RG, Adamek D, Fangusaro J, Scharnhorst D, Johnston D, Lafay-Cousin L, Camelo-Piragua S, Kabbara N, Gajjar A, Boutarbouch M, da Costa MJG, Hanson D, Wood P, Al-Hussaini M, Amayiri N, Wang Y, Catchpoole D, Michaud J, Bendel AE, Ellezam B, Gerber N, Plant A, Jeffery R, Dunham C, Moertel C, Walter A, Ziegler D, Dodgshun A, Gottardo N, Demir A, Ramanujachar R, Raabe E, Mary S, Dirks P, Taylor M, Eugene H, Lindsey H, Tihan T, Mette J, Dahl C, Low S, Smith A, Hazrati LN, Kresak J, Gino S, Tan E, Morales A, Santa-Maria V, Hawkins C, Bartels U, Stephens D, Nobusawa S, Dufour C, Bourdeaut F, Andre N, Bouffet E, Huang A. ETMR-22. TITLE: DEFINING THE CLINICAL AND PROGNOSTIC LANDSCAPE OF EMBRYONAL TUMORS WITH MULTI-LAYERED ROSETTES (ETMRs), A RARE BRAIN TUMOR REGISTRY (RBTC) STUDY. Neuro Oncol 2020. [PMCID: PMC7715263 DOI: 10.1093/neuonc/noaa222.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
ETMR, an aggressive disease characterised by C19MC alterations, were previously categorised as various histologic diagnoses. The clinical spectrum and impact of conventional multi-modal therapy on this new WHO diagnostic category remains poorly understood as a majority of ~200 cases reported to date lack molecular confirmation. We undertook comprehensive clinico-pathologic studies of a large molecularly confirmed cohort to improve disease recognition and treatment approaches. Amongst 623 CNS-PNETs patients enrolled in the RBTC registry, 159 primary ETMRs were confirmed based on a combination of FISH (125), methylation analysis (88), SNP and RNAseq (32) analyses; 91% had C19MC amplification/gains/fusions, 9% lacked C19MC alterations but had global methylation features of ETMR NOS. ETMRs arose in young patients (median age 26 months) predominantly as localized disease (M0-72%, M2-3 -18%) at multiple locations including cerebrum (60%) cerebellum (18%), midline structures (6%); notably 10% were brainstem primaries mimicking DIPG. Uni-and multivariate analyses of clinical and treatment details of curative regimens available for 110 patients identified metastatic disease (p=0.002), brainstem locations(p=0.005), extent of surgery, receipt of multi-modal therapy including high dose chemotherapy and radiation (P<0.001) as significant treatment prognosticators, while C19MC status, age and gender were non-significant risk factors. Analyses of events in all patients showed respective EFS at 3 and 12 months of 84%(95%CI:77–91) and 37%(95%CI:20–41) and 4yr OS of 27%(95%CI:18–37) indicating despite intensified therapies ETMR is a rapidly progressive and fatal disease. Our comprehensive data on the largest cohort of molecularly-confirmed ETMRs provides a critical framework to guide current clinical management and development of clinical trials.
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Affiliation(s)
- Sara Khan
- Arthur and Sonia Labatt Brain Tumor Research Centre, Toronto, Ontario, Canada
- Hudson Institute of Medical Research, Monash University, Melbourne, Victoria, Australia
| | - Palma Solano-Paez
- Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatric Oncology, Hospital Infantil Virgen del Rocio, Sevilla, Spain
| | - Tannu Suwal
- Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Salma Al-Karmi
- Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Mei Lu
- Arthur and Sonia Labatt Brain Tumor Research Centre, Toronto, Ontario, Canada
| | - Ben Ho
- Arthur and Sonia Labatt Brain Tumor Research Centre, Toronto, Ontario, Canada
| | - Maryam Fouladi
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Sarah Leary
- Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, WA, USA
| | | | - Alvaro Lassaletta
- Pediatric Hematology and Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Eloy Rivas
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Alyssa Reddy
- University of Alabama at Birmingham, Birmingham, USA
| | - G Yancey Gillespie
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, USA
| | - Nalin Gupta
- Department of Neurological Surgery, University of California, California, San Francisco, CA, USA
| | - Michal Yalon-Oren
- Department of Pediatric Neuro-Oncology, Sheba Medical Centre, Tel HaShomer, Ramat Gan, Israel
| | - Laura Amariglio
- Department of Pediatric Neuro-Oncology, Sheba Medical Centre, Tel HaShomer, Ramat Gan, Israel
| | - Hideo Nakamura
- Department of Neurosurgery, Kumamoto University, Kumamoto, Japan
| | | | | | - Young-Shin Ra
- Department of Neurosurgery, Asan Medical Center, Seoul, Repulic of Korea
| | - Milena La Spina
- Paediatric Haematology and Oncology Division, University of Catania, Sicily, Italy
| | | | - Luca Massimi
- Department of Neurosurgery, Agostino Gemelli University Hospital, Rome, Italy
| | | | - Jordan R Hansford
- Children’s Cancer Centre, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Richard G Grundy
- Children’s Brain Tumor Research Centre, Queen’s Medical Centre University of Nottingham, Nottingham, United Kingdom
| | - Dariusz Adamek
- Department of Pathomorphology, Jagiellonian University Medical College, Krakow, Poland
| | - Jason Fangusaro
- Department of Pediatric Hematology and Oncology, Children’s Healthcare of Atlanta and the Emory University School of Medicine, Atlanta, GA, USA
| | - David Scharnhorst
- Department of Pathology, Valley Children’s Hospital, Madera, CA, USA
| | - Donna Johnston
- Department of Pediatrics Division of Hematology/Oncology, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Lucie Lafay-Cousin
- Department of Pediatric Oncology, Alberta Children’s Hospital, Calgary, AB, Canada
| | | | - Nabil Kabbara
- Division of Pediatric Hematology Oncology, Rafic Hariri University Hospital, Beirut, Lebanon
| | - Amar Gajjar
- Division of Neuro-Oncology, Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Mahjouba Boutarbouch
- Department of Neurosurgery, Mohamed Vth, University, School of Medicine, Hôpital des Spécialités, ONO CHU Ibn Sina, Rabat, Morocco
| | - Maria Joao Gil da Costa
- Pediatric Hemathology and Oncology Division, University Hospital S, João Alameda Hernani Monteiro, Porto, Portugal
| | - Derek Hanson
- Division of Hematology-Oncology, Steven and Alexandra Cohen Children’s Medical Center, Northwell Health, New York, NY, USA
- Children’s Hospital, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Paul Wood
- Monash Children’s Hospital, Melbourne, VIC, Australia
| | | | | | - Yin Wang
- Department of Neuropathology Huashan Hospital Fudan University, Shanghai, China
| | - Daniel Catchpoole
- The Tumour Bank, Children’s Cancer Research Unit, Kids Research Institute, the Children’s Hospital at Westmead, NSW, Australia
| | - Jean Michaud
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Eastern Ontario, Ottawa, Canada
| | - Anne E Bendel
- University of Minnesota Medical School Minneapolis, MN, USA
| | - Benjamin Ellezam
- Department of Pathology, CHU Sainte-Justine Research Center, Université de Montréal, Montreal, QC, Canada
| | - Nicholas Gerber
- Department of Oncology, University Children’s Hospital, Zurich, Switzerland
| | - Ashley Plant
- Division of Pediatric Oncology, Children’s Hospital of Orange County, Orange, CA, USA
| | - Rubens Jeffery
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher Dunham
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Christopher Moertel
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN, USA
| | - Andrew Walter
- Division of Pediatric Hematology/Oncology duPont Hospital for Children, Wilmington, DE, USA
| | - David Ziegler
- Children’s Cancer Institute, University of New South Wales, NSW, Australia
| | - Andrew Dodgshun
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | | | - Ahmet Demir
- Department of Hematology, Trakya University Medical Faculty, Edirne, Turkey
| | - Ramya Ramanujachar
- Paediatric Haematology and Oncology, Southampton Children’s Hospital, South Hampton, United Kingdom
| | - Eric Raabe
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Division of Pediatric Oncology, Baltimore, MD, USA
| | - Shago Mary
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Peter Dirks
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Hwang Eugene
- Department of Oncology, Children’s National Medical Center, Washington, DC, USA
| | - Holly Lindsey
- Center for Cancer and Blood Disorders, Phoenix Children’s Hospital, Phoenix, AZ, USA
| | - Tarik Tihan
- Department of Pathology, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Jorgensen Mette
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Christine Dahl
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Sharon Low
- Neurology Service, Department of Pediatrics, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Amy Smith
- Orlando Regional Medical Center, Orlando, FL, USA
| | | | - Jesse Kresak
- Orlando Regional Medical Center, Orlando, FL, USA
| | - Somers Gino
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Enrica Tan
- Paediatric Haematology/Oncology Service, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Andres Morales
- Neuro Oncology Unit Department of Pediatric Hematology, Oncology and Stem Cell Transplantation St Joan de Déu Children′s Hospital, Barcelona, Spain
| | - Vicente Santa-Maria
- Neuro Oncology Unit Department of Pediatric Hematology, Oncology and Stem Cell Transplantation St Joan de Déu Children′s Hospital, Barcelona, Spain
| | | | - Ute Bartels
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Christelle Dufour
- Département de Cancérologie de l’Enfant et de l’Adolescent, Institut Gustave Roussy, Villejuif, Paris, France
| | - Franck Bourdeaut
- PSL Research University, Institut Curie Research Center, Paris, France
| | | | - Eric Bouffet
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Annie Huang
- Arthur and Sonia Labatt Brain Tumor Research Centre, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
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